Bleeding during pregnancy: What's NOT normal

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Losing blood when pregnant can be terrifying. Find out what causes bleeding during pregnancy and what you can do about it

Bleeding during pregnancy can be unsettling for the mum-to-be. Of all the possible pregnancy problems, noticing a bloody discharge can make you panic and assume the worst. However, it’s important to note that losing a little blood does not always indicate a miscarriage. In fact, spotting is fairly common and occurs in about one-third of all pregnancies.

“Spotting or light bleeding during pregnancy is often harmless. With adequate bed rest and medication, many pregnancies achieve full term despite early bleeding problems,” says Dr Papia Goswami Mukherjee, consultant gynaecologist, Kumar Clinic, Mumbai.

While spotting poses no threat to the mother and her growing baby, bleeding, on the other hand, can be indicative of a variety of complications including miscarriage, ectopic pregnancy, placental abruption or placenta previa. It thus, should never be ignored. Here are some common causes for spotting and bleeding during pregnancy.

Bleeding during pregnancy in the first 20 weeks

About 20% women may experience vaginal bleeding during the first trimester. Dr Mukherjee lists the various reasons for spotting or bleeding in the first half of pregnancy.

  • Implantation bleeding

Some women may experience some normal spotting in early pregnancy as the fertilized egg implants itself in the lining of the uterus. “The fertilised egg travels down the fallopian tube and into the uterus, where it implants into the uterine lining. The process may damage some of the mother’s blood vessels in the uterus, resulting in a small amount of blood leaking from the cervix and down the vagina,” informs Dr Mukherjee. Since implantation bleeding occurs very early on in pregnancy, it may often be mistaken for a light period.

  • Changes in level of hormones

Hormones that usually control the menstrual cycle may trigger bleeding in early pregnancy.

  • Cervical or vaginal infection

Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhoea, or herpes) can cause bleeding in the first trimester. Infections during pregnancy need timely medication under a doctor’s advice.

  • Sexual intercourse

During pregnancy, extra blood flows to the cervix. Pregnancy hormones can change the surface of the cervix, making it more susceptible to bleeding after friction, such as during sexual intercourse.

  • Fibroids

At times, the placenta may embed in an area where there is a fibroid or growths in the lining of the uterus and cause bleeding. This does not cause harm to the baby.

Sometimes, bleeding during the first 20 weeks of pregnancy can indicate a more serious problem needing immediate intervention. These could be:

  • Miscarriage

Since miscarriages are most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns of first trimester bleeding. Early miscarriage usually happens when the embryo is not developing properly. “Some women even have a miscarriage before they realize they’re pregnant, and assume they’re having a period,” says Dr Mukherjee.

  • Subchorionic haemorrhage

Bleeding and small clot formations around the placenta may happen in early pregnancy.

  • Ectopic pregnancy

In an ectopic pregnancy, the fertilised embryo implants outside of the uterus, usually in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life threatening to the mother.

  • Molar pregnancy

A molar pregnancy is a rare condition in which abnormal tissue grows inside the uterus instead of a baby. It happens when the embryo doesn’t develop properly, but some of the cells that form the placenta continue to grow and multiply. In rare cases, the tissue may be cancerous and can spread to other parts of the body.

  • Chemical pregnancy

When an egg is fertilised but never fully implants in the uterus, it leads to a condition called chemical pregnancy. This can be diagnosed by checking the pregnancy hormone levels.

Continue reading to know what causes bleeding in trimester two.

bleeding during pregnancy

Bleeding during the second half of the pregnancy could be serious so inform your doctor at once

Bleeding in the second half of pregnancy

Early pregnancy complications such as ectopic pregnancy and chemical pregnancy are ruled out during later stages of gestation. The risk of miscarriage also considerably drops after the first trimester. However, bleeding during the second half of pregnancy must be taken seriously. The reasons for bleeding during this period could indicate:

The start of labour

Usually, labour starts with a small discharge of blood mixed with mucus from the vagina. “This discharge, called the ‘bloody show’, occurs when small veins are torn as the cervix begins to dilate. The amount of blood in the discharge is small,” informs Dr Mukherjee. Onset of labour is the most common reason for late pregnancy bleeding.

If a pregnant woman experiences cramping pain with slight bleeding before 36 weeks, she may be experiencing preterm labour. This needs immediate intervention.

Placental abruption

Placental abruption is very serious condition in which the placenta detaches from the wall of the uterus and blood pools between the placenta and uterus. This can be very dangerous to both the mother and baby.

Placenta previa

This condition occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. “Bleeding may occur in placenta previa without warning, or it may be triggered when a practitioner examines the cervix to determine whether it is dilating or whether labour has started,” says Dr Mukherjee.

Ruptured uterus

In rare cases, a scar from a previous caesarian section can tear open during pregnancy. Uterine rupture can be life threatening.

Vasa previa

In this rare condition, the developing baby’s blood vessels in the umbilical cord or placenta cross the opening to the birth canal. When labour starts, these small blood vessels may tear, depriving the foetus of blood. Vasa previa can be dangerous to the baby as the baby can bleed severely and lose oxygen.

When you bleed during pregnancy

Whether you spot or bleed, losing any amount of blood when you’re expecting a baby could be a sign of a problem, so informing your doctor is a must. If you observe any bloody discharge during pregnancy, don’t forget to:

  • Wear a pad so that you can keep track of how much you’re bleeding, and record the type of blood passed (for example, pink, brown, or red, smooth or full of clots). You may be a bundle of nerves but doing this will help your doctor diagnose the problem faster.
  • Bring any tissue that passes through the vagina to your doctor for testing.
  • Avoid using a tampon if you bleed during pregnancy
  • Avoid sexual intercourse while you are still spotting/bleeding
  • Mention a previous bleeding/spotting episode to your doctor even if it has stopped
  • Watch out for symptoms like cramping abdominal pain, back pain, excessive nausea/vomiting and fainting attacks along with the spotting

To confirm the cause of bleeding/spotting, a doctor may:

  • Perform a clinical examination
  • Conduct an ultrasound scan
  • Test urine and blood to check pregnancy hormonal levels
  • Check your blood group and Rh status, complete blood count and clotting time

Depending on the results, further evaluation will be done to ascertain the cause for bleeding.

So if you do notice some blood during your bathroom visit during early pregnancy, try to relax but do keep your doctor in the loop. Chances are she might just tell you to put your feet up and rest so that you can be back on your feet and enjoy pregnancy to the fullest.

References: WebMD

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Written by

Preeti Athri